The personal web journal of the Honorable Erik R. Fleming, the 2006 & 2008 Democratic nominee for the United States Senate from Mississippi and former member of the Mississippi House of Representatives.

Monday, January 23, 2012

Radical Idea #1: Changing Medicaid

Having been a candidate for the United States Senate, my thought process has been focused more at a national level than a local one for quite some time. Although I totally base my national thought process on how it would improve the lives of the people in my adopted home state of Mississippi, it is a national thought process nonetheless.

Upon expressing that, I also believe that the country that I live in has gotten into a rut concerning radical political policy. We have truly become a country of political cowards, deeming every man-made policy as a sacred institution, that whenever some think about changing the way we do things, those individuals are treated as heretics or blasphemers.

Well, since I am not a candidate on any ballot in the year 2012, I have nothing to lose by expressing my thoughts about radical changes that need to be made to make my country great again. My reputation in the Mississippi Legislature was to introduce legislation to provoke thoughtful discussion and hopefully change policy for the betterment of the people I served. It is in that sense of self-made tradition that I offer this suggestion.

Medicaid was instituted in 1965 to provide medical aid to a limited number of low-income Americans receiving government financial assistance. In 2010, the cost to the Federal Government to operate this noble endeavor was $275 billion. With increasing medical costs, this program could basically take up half of the Federal budget over the next ten generations. That thought alone makes the current way we deliver Medicaid cost prohibitive in the long term.

I say let's do something radically different with the way we allocate Medicaid dollars. Instead of Medicaid being essentially a medical insurance policy for impoverished Americans, let it become a grant program for those same Americans to get quality, private health insurance. If the recent health care reform law survives the Supreme Court's constitutional review, it will be a requirement for every American to have health insurance by 2014. Why not make Medicaid the delivery system to make that happen?

For what we are paying now for some 45 million Americans to have complete annual health care access, we can pay a $183 monthly premium for every American for five months. Thus if we applied that same monthly premium payment for those same 45 million Americans for a year, it would only be $99 billion, a savings of almost $175 billion. The $183 monthly premium number is the average Americans paid for individual health insurance in 2011. The average deductible was around $2500.

Now the critics will say that insurance companies will not want to insure these individuals because of the propensity for increased payouts. My argument is that health insurance will always have a greater propensity for payouts compared to life, auto or property insurance regardless of the clientele because of the nature of the insurance. Everybody wants to be healthy, therefore they will do what is necessary to be that way, which means going to the doctor when they are not feeling well.

The way the system is setup now, people run to the emergency room when things become a crisis, there is no incentive for preventive care and the majority of Americans cannot identify a family physician when asked. Private insurers offer those wellness incentives with their policies.

The specifics for cost controls within the new Medicaid program could be legislated, but they do not have to go any further than within the current program. Currently, several states offer Medicaid/SCHIP-funded premium assistance programs already. My contention is that the premium assistance program should be the primary focus of the new Medicaid program I am suggesting.

This will help states trim down or totally eliminate their Medicaid burden, which is essentially a Federal tax assessed on the states in the form of matching funds, thus freeing up their respective budgets. And if the states have more money, then taxes do not have to be raised to cover these increasing costs and maybe they might put more money in other programs, say like education for example.

Also, with the insurance companies having more skin in the game, so to speak, then the private industry of insurance can challenge the private industry of health care to deal with controlling the cost of health care and pharmaceuticals without the immediate threat of the government clamping down on the free market system as it relates to health care.

There will be those in the social justice community that will state this places an undue burden of the poor. That argument is hallow in light of the fact that the President they supported mandated that everyone must have health insurance and it is unrealistic in these political and economic climates to expect any elected official to just raise taxes to pay for a service that rises quicker than any pay raise or tax increase, or the rate of inflation for that matter.

This radical idea stays within the Preamble of the US Constitution in regards to promoting the general welfare, but it adds that dimension of individual responsibility that is needed for a society, and the very basic unit of that society, the family, to survive.

Again, this is my radical idea. Every idea I have heard so far basically cuts out the families that are already under the system and does not create the environment for thorough discussion, let alone consensus, of controlling the cost of health care. This one, I believe, relieves the pressure of the Medicaid program on the Federal and the respective states' budgets while providing a much needed program to the citizens of this great nation.

I am sure I am not the only one who has thought about this but I am putting it out there. Maybe, as it was when I was in the Mississippi House of Representatives, this will get people talking about it and, more importantly, doing something about it. Because that is what enabling public policy is all about.